The toxic effects of amphotericin B in man

Studies of 47 patients with intravenous amphotericin B revealed some impairment of renal function in all cases. Azotemia developed in 46 cases. Microscopic examination in eight cases showed damage to the distal renal tubule. Profound hypokalemia was recognized in two cases; and symptoms suggesting hypokalemia, which were generally ameliorated by potassium administration, were noted in most cases. It is postulated that the initial potassium loss is due to a "tubular leak" and that subsequent potassium depletion leads to further tubular damage. Mild to severe anemia developed in all cases during therapy. Serial red cell indices, bone marrow examinations and red cell survival studies indicated that hemolysis, rather than bone marrow depression, was responsible.The decision to treat, to modify therapy or to terminate treatment must be made on the basis of severity of disease, probability of progression, and renal status.

IDENTIFICATION OF THE COMPONENTS OF COMPLEMENT PARTICIPATING IN THE ANTIGLOBULIN REACTION

Red cells sensitized with a complement-binding antibody and then incubated with fresh serum have been shown to be coated with β_1C and β_1E globulin, two components of the complement system that have been isolated recently. Red cells presumably in the state EAC′_1,4 reacted with anti-β_1E, and cells presumably in the state EAC′_1,4,2,3a reacted with anti β_1E and with anti-β_1C. Agglutination of complement-coated cells by `broad spectrum' antiglobulin sera was effectively inhibited by purified β_1E and β_1C globulin. Red cells from certain patients with acquired haemolytic anaemia were found to be coated in vivo with β_1E and β_1C globulin. The function and significance of the two serum components have been discussed.